Provider Demographics
NPI:1184292690
Name:DEREK Y. NISHIMORI, D.D.S., INC.
Entity type:Organization
Organization Name:DEREK Y. NISHIMORI, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:YUTAKA
Authorized Official - Last Name:NISHIMORI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-279-8080
Mailing Address - Street 1:2034 FOREST AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2034 FOREST AVE STE 1A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4809
Practice Address - Country:US
Practice Address - Phone:408-279-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental